Stroke (Cerebrovascular Accident): Epidemiological, Clinical and Evolving Aspects in the Internal Medicine Department of the Public Health Establishment 1 (EPS1) of Tivaouane

Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.

Medical Direct Cost of Hospital Admission for Cerebrovascular Accident on Medical Recovery at the Sylvanus Olympio Teaching Hospital of Lomé

Objectives: Appreciate the Medical direct cost for cerebrovascular accident on medical recovery at the Sylvanus Olympio Teaching Hospital of Lomé. Patients and method: This was a prospective and cross study that took place from 01st October 2015 to 31st July 2016 in the medical recovery Unit of Sylvanus Olympio Teaching Hospital of Lomé. Results: Of the 91 stroke patients surveyed, the average age was 55.1 years;the sex-ratio (Men/women) was 1.3 and only 8.8% of patients had benefited from INAM (National Institute of Health Insurance) granting of benefits. The proportion of ICVA was 73.6% compared to 26.4% for the MCVA. The average overall cost of granting benefits of a CVA patient was 312,245 FCFA for an average stay of 18.6 days. This cost was 399.115 FCFA in MCVA for an average stay of 19.0 days against 281.130 FCFA in ICVA for an average stay of 16.1 days. Conclusion: CVAs on the one hand inflict losses of national productivity by its handicap, and a heavy economic burden for both patients and their families on the other hand, by its high cost of granting of benefits;Hence there is the need for assistance of all kinds by national and international health actors.

RESEARCH ON SEQUELAE OF CEREBROVASCULAR ACCIDENT TREATED BY THREE DIFFERENT NEEDLING TECHNIQUES

One hundred and sixty cases of sequelae of cerebrovascular accident (CVA) wererandomly divided into three groups: The temporal point group (TG), 58 cases; the scalp acupuncturegroup(SG), 52 cases; the body acupuncture group(BG), 50 cases. It was shown that after 30 treat-ments the curative effects were significantly different (P【0. 01) among the three groups. The effectin TG was better than those in SG and BG. There was no difference in curative effects between SGand BG. It is indicated that all the three needling techniques can improve encephalic blood flow in pa-tients. It seems that the effects of the three needling techniques are as follows: TG】SG】BG.

Predictors of a Cerebrovascular Accident in a Population of Systemic Sclerosis Patients Followed at a Large Academic Center with a Dedicated Scleroderma Center

Aim: The aim of this study is to describe the clinical characteristics of patients with a diagnosis of systemic sclerosis who later suffer a stroke and to identify associations for this relationship. Background: Prior studies have showed an increased risk of cardiovascular disease among patients with chronic inflammatory disorders, with chronic inflammation leading to atherosclerosis believed to be the culprit. Systemic sclerosis (SSc) is a chronic inflammatory disease characterized by diffuse fibrosis of the skin and internal organs. Previous studies have suggested a possible link between systemic sclerosis and macrovascular complications such as stroke. Methods: This is a retrospective chart review of patients treated within the University of Pennsylvania Health System from October 2015 to April 2019 with a diagnosis of SSc. Using ICD10 codes, we identified a cohort of SSc patients who suffered a stroke. Information regarding demographics and stroke risk factors were gathered from the charts of patients with a diagnosis of both SSc plus stroke and compared to a control group of randomly selected patients with SSc who never suffered a stroke. Continuous variables were conveyed using a mean plus a standard deviation. A two-sample t-test was used to compare the two groups of patients. Qualitative variables were compared using a two-tailed Fisher’s exact test. Results: Based on a large cohort of SSc patients (n = 2080) followed between October 2015 and April 2019, we identified 36 SSc patients who developed a subsequent stroke (1.7% of cohort). When looking at risk factors for stroke in SSc patients, we identified hypertension and atrial fibrillation to be associated with the diagnosis of stroke in such patients. Specifically, 28 of the 36 patients with both SSc and stroke also had a diagnosis of hypertension while in the control group, only 17 of 36 patients had hypertension. Atrial fibrillation was seen in 9 of 36 patients with both SSc and CVA while it was seen in only 2 of 36 patients in the control group. Conclusions: This case control study demonstrated that the presence of hypertension and atrial fibrillation had a statistically significant association with the diagnosis of CVA in patients with SSc.

Traumatic Brain Injury and Cerebral Vascular Accident: Application of Rasch Analysis to Examine Differences in Disability and Outcome in Post-Hospital Rehabilitation

The purpose of this study was to demonstrate an application of Rasch analysis to identify differences in disability profiles resulting from traumatic brain injury (TBI) and cerebral vascular accident (CVA) and to examine outcome differences between the two groups following post-hospital residential rehabilitation. Participant data were collected from 32 facilities in 16 states. From 2990 neurologically impaired individuals with consecutive admissions from 2011 through 2017, 874 met inclusion criteria: TBI (n = 687) or CVA (n = 187), 18 years or older, minimum length of stay of one month, and maximum chronicity of 1 year. Participants were evaluated at admission and discharge on the Mayo Portland Adaptability Inventory-Version 4 (MPAI-4). Rasch analysis was performed to establish item reliability, construct validity and item difficulty. A Repeated Measures Multivariate Analysis of Covariance (RM MANCOVA) determined group differences and improvement from admission and discharge. Rasch Analysis demonstrated satisfactory construct validity and internal consistency (Person reliability > 0.90, Item reliability > 0.98 for admission and discharge MPAI-4s). Both groups showed significant improvement on the MPAI-4 (p 0.0005). The TBI group was more impaired on the adjustment scale at both admission and discharge (p 0.001). Rasch analysis identified two distinct impairment patterns. CVA participants exhibited deficits characteristic of focal impairment while the TBI group presented with deficits reflective of diffuse impairment. Rehabilitation was shown to be beneficial in reducing disability following neurologic injury in both groups. Importantly, Rasch Analysis accurately produced unique disability profiles that differentiated the treatment groups. This unique statistical technique offers a promising prescriptive hierarchical model for guiding neurological rehabilitation treatment.

Acupuncture combined with Buyang Huanwu decoction in the treatment of sequelae of cerebrovascular accident:a systematic review and meta-analysis

Background:Cerebrovascular accident has high morbidity,high disability,and high mortality,possibly causing several serious sequelae and bringing a heavy burden to the patient,the family,and the society.Buyang Huanwu decoction,a classic ancient prescription of traditional Chinese medicine,and acupuncture are often used in combination to treat the sequelae of cerebrovascular accident.In the present study,we systematically evaluated the clinical efficacy and safety of acupuncture combined with Buyang Huanwu decoction in treating the sequelae of cerebrovascular accident.Methods:Relevant randomized controlled trials of acupuncture combined with Buyang Huanwu decoction in treating the sequelae of cerebrovascular accident were comprehensively retrieved from electronic databases from inception to May 8,2020,including PubMed,Embase,The Cochrane Library,China National Knowledge Infrastructure,WanFang Data,and China Science and Technology Journal Database.The main outcomes of clinical efficacy,degree of nerve function impairment,daily self-care capacity,Fugl-Meyer locomotor function score,life quality score,and occurrence of adverse reactions were subjected to meta-analysis.Results:The 28 randomized controlled trials included 2,341 patients with the sequelae of cerebrovascular accident.Systematic review and meta-analysis indicated that compared with acupuncture alone,its combined treatment with Buyang Huanwu decoction significantly increased clinical efficacy(RR=1.19,95%CI(1.14,1.23),P<0.001),improved nerve function impairment(WMD=−4.89,95%CI(−8.25,−1.53),P=0.004),promoted daily self-care capacity(WMD=15.87,95%CI(11.22,20.51),P<0.001),strengthened Fugl-Meyer locomotor function(WMD=20.89,95%CI(13.79,27.98),P<0.001),enhanced physical functioning(WMD=16.99,95%CI(6.01,27.96),P<0.001)and mental health(WMD=16.91,95%CI(9.14,24.69),P<0.001)in terms of life quality score(SF-36 scale)of patients with sequelae of cerebrovascular accident,with few adverse reactions.Conclusion:Compared with acupuncture alone,its combination with Buyang Huanwu decoction had better comprehensive effects on sequelae of cerebrovascular accident without obvious adverse reactions.

脑卒中患病影响因素的研究现状

随着脑卒中的发病率逐年升高,给社会、家庭和患者带来了巨大的痛苦、经济压力和社会负担,因而加强其疾病因素的分类、研究和预警,对降低发病率和死亡率具有重要意义。因此,本文从不可控因素(年龄、性别、遗传、环境等)、疾病因素(高血压、糖尿病、高血脂、冠心病、偏头痛等)、个人因素(生活习惯、心理因素、睡眠因素等)、其他因素等方面对脑卒中发病的影响因素进行综述,以期为脑卒中的预防、治疗和护理提供依据。

综合性康复疗法治疗脑血管意外偏瘫的临床疗效评价

目的分析脑血管意外偏瘫患者使用综合性康复疗法的临床疗效。方法方便选择宁津县人民医院于2021年8月—2023年6月收治的106例脑血管意外偏瘫患者作为研究对象,以随机数表法分为对照组和观察组,每组53例。对照组采用常规康复疗法,观察组采用综合性康复疗法,对比两组临床疗效、肢体运动功能评分、日常生活能力评分、神经功能缺损程度评分。结果治疗后,观察组临床总疗效(94.34%)高于对照组(79.25%),差异有统计学意义(χ^(2)=5.267,P<0.05);观察组肢体运动功能评分、日常生活能力评分、神经功能缺损程度评分均优于对照组,差异有统计学意义(P均<0.05)。结论综合性康复疗法对于提升脑血管意外偏瘫的临床疗效具有重要作用,且可以提升患者肢体运动功能、日常生活能力,改善神经功能缺损问题。

Rehabilitation therapy centralized on facilitation and acupuncture on upper extremities spasm after stroke

AIM: To observe the therapeutic effect of rehabilitation therapy centralized on facilitation and acupuncture on upper extremities spasm after stroke.METHODS:56 cases of stroke patients with upper extremities spasm were divided into two groups by random.28 patients in treatment group were received rehabilitation therapy centralized on facilitation and acupuncture treatment.Others in control group were received traditional method. RESULT:All patients were evaluated by muscle tone evaluation of Ashworth Scale.The outcomes of two groups had significant different (P< 0.01). CONCLUSION:We could archive the satisfactory effects with acupuncture and rehabilitation therapy centralized on facilitation on upper extremities spasm of stroke patients.

侧卧位直接前路全髋关节置换治疗伴有偏瘫的股骨颈骨折的近期疗效观察

目的观察侧卧位直接前路(direct anterior approach,DAA)人工全髋关节置换手术治疗脑血管意外患者偏瘫侧股骨颈骨折的近期疗效。方法回顾性分析亳州市人民医院骨科2018年1月—2020年8月收治的因脑血管意外而致偏瘫侧肢体发生股骨颈骨折的患者57例,按入院后不同治疗分为DAA组和后外侧入路组。DAA组29例采用侧卧位DAA人工全髋关节置换手术治疗,男性15例,女性14例;年龄57~70岁,平均68.3岁;道路交通伤9例,摔伤15例,高处坠落伤5例。后外侧入路组28例采用常规后外侧入路人工全髋关节置换手术,男性14例,女性14例;年龄63~69岁,平均66.6岁;道路交通伤9例,摔伤14例,高处坠落伤5例。观察记录两组患者伤口长度、手术时间、术中失血量、住院时间,术后3、7d疼痛视觉模拟评分(visual analogue scale,VAS),术前及术后1、3、6、16个月随访时髋关节功能评分、手术并发症等,评定侧卧位DAA入路髋关节置换对偏瘫侧肢体股骨颈骨折治疗的安全性和有效性。结果患者均顺利完成手术,DAA组较后外侧入路组切口长度短[(9.32±2.23)cm vs.(11.1±2.43)cm]、手术时间长[(79.3±8.9)min vs.(72.2±8.7)min]、术中出血量少[(181.6±34.2)mL vs.(211.3±42.2)mL]、住院天数少[(7.3±1.3)d vs.(8.9±1.5)d],比较差异有统计学意义(P<0.05)。术后3、7d两组VAS比较差异有统计学意义(Z=-2.357,P=0.018;Z=-2.576,P=0.010)。患者均门诊随访8~16个月,DAA组患者术后1、3个月随访髋关节评分显著优于后外侧入路组(P<0.05),但术后6、16个月两组数据差异无统计学意义(P>0.05)。DAA组2例患者伤口渗液,其余伤口正常愈合;所有患者正常活动均无脱位,无深部组织及假体感染。后外侧入路组患者1例术后2个月假体感染,4例患者术后3个月内活动时脱位。末次随访两组患者X线片未见假体松动现象。结论侧卧位DAA全髋关节置换手术治疗因脑血管意外致偏瘫侧肢体股骨颈骨折创伤小,住院时间短,术后恢复快,值得临床推广应用。

卵巢癌并发急性缺血性脑卒中患者的急救护理

总结1例卵巢癌患者并发急性缺血性脑卒中的护理体会。针对患者脑卒中症状不典型、需短时间明确诊断和启动溶栓治疗等问题,护士及时启动快速反应团队、主导多学科合作;溶栓期间加强出血风险监测及管理;新辅助化疗期间重点防范梗死;进行分阶段康复训练,促进肢体康复。经过精心护理,顺利出院。后续及时、足量完成化疗择期行手术治疗,随访3个月,患者状况良好。

Characteristics and risk factors of cerebrovascular accidents after percutaneous coronary interventions in patients with history of stroke

Background Percutaneous coronary intervention （PCI） is a well-established method for managing coronary diseases. However, the increasing use of PCI has led to an increased incidence of acute cerebrovascular accidents （CVA） related to PCI. In this study, we investigated the characteristics and risk factors of CVA after PCI in patients with known stroke history. Methods Between January 1, 2005 and March 1, 2009, 621 patients with a history of stroke underwent a total of 665 PCI procedures and were included in this retrospective study. Demographic and clinical characteristics, previous medications, procedures, neurologic deficits, location of lesion and in-hospital clinical outcomes of patients who developed a CVA after the cardiac catheterization laboratory visit and before discharge were reviewed. Results Acute CVA was diagnosed in 53 （8.5%） patients during the operation or the perioperative period. Seventeen patients suffered from transient ischemic attack, thirty-four patients suffered from cerebral infarction and two patients suffered from cerebral hemorrhage. The risk factors for CVA after PCI in stroke patients were： admission with an acute coronary syndrome, use of an intra-aortic balloon pump, urgent or emergency procedures, diabetes mellitus, and poor left ventricular systolic function, arterial fibrillation, previous myocardial infarction, dyslipidemia, tobacco use, and no/irregular use of anti-platelet medications. Conclusions The incidence of CVA during and after PCI in patients with history of stroke is much higher than that in patients without history of stroke. Patients with atrial fibrillation, previous myocardial infarction, diabetes mellitus, dyslipidemia, tobacco use, and no or irregular use of anti-platelet medications were at higher risk for recurrent stroke. This study showed a strong association between acute coronary svndromes and in-hospital stroke after PCI.

脑血管意外56例尸检临床病理分析

目的 了解脑血管意外中各种死亡原因所占的比例。方法 回顾性分析脑血管意外56例尸检报告,并对其死亡原因进行分类、统计和分析。结果 脑血管意外56例尸检报告中,直接死因主要包含脑出血和脑梗死两大类,其中脑出血37例(66%),脑梗死19例(34%);出现脑血管意外的疾病因素有8类,分别为高血压11例(20%),脑血管畸形9例(16%),血液病及凝血障碍7例(13%),脑先天性动脉瘤6例(11%),脑肿瘤6例(11%),脑栓塞9例(16%),脑血栓形成6例(11%),动脉粥样硬化有关的血管破裂2例(4%)。结论 脑血管意外中脑出血发病多于脑梗死,脑出血多因死者出现高血压性或血管畸形破裂所导致;脑梗死中脑栓塞多于脑血栓的形成,同时脑血管畸形多于先天性动脉瘤。

老年药物性低血糖临床误诊分析

目的 探讨老年药物性低血糖的临床特点及误诊原因、防范措施。方法 回顾性分析2020年1月—2022年3月收治的曾误诊的老年药物性低血糖11例的临床资料。结果 本组年龄60~74岁;糖尿病病程2~18年;有高血压病史7例,脑梗死病史和冠心病史各2例。7例以不同程度意识障碍就诊,有单侧肢体活动不利,2例CT检查发现陈旧性脑梗死灶,初步诊断为急性脑血管意外;4例以心悸、胸闷、乏力、多汗就诊,1例伴心前区疼痛,心电图检查示ST段压低,一~二度房室传导阻滞,初步诊断为冠心病。误诊时间2~4 h。11例经综合分析病史及血糖检测结果等,均确诊为药物性低血糖,给予葡萄糖注射液等治疗症状逐渐好转并消失,随访2个月无复发。结论 老年药物性低血糖患者交感神经兴奋症状较轻微,易误诊为心脑血管疾病。提高基层医院接诊医生对药物性低血糖的重视,仔细询问降糖药物使用史、平时血糖控制情况及发病前饮食情况,及早行血糖检测,有利于避免药物性低血糖误诊。

优质急诊护理在脑血管意外患者中的应用效果

目的分析优质急诊护理在脑血管意外患者中的应用效果。方法选取2019年1月至2021年7月在急诊就诊的92例脑血管意外患者,将其随机分为对照组和观察组,各46例。对照组给予常规急诊护理,观察组给予优质急诊护理。比较两组的干预效果。结果观察组的等待救治时间、达计算机断层扫描(CT)室时间短于对照组,差异具有统计学意义(P<0.05)。观察组的抢救成功率高于对照组,差异具有统计学意义(P<0.05)。干预后3 d,观察组的格拉斯哥昏迷量表(GCS)评分高于对照组,美国国立卫生研究院卒中量表(NIHSS)评分低于对照组,差异具有统计学意义(P<0.05)。干预后1个月,观察组的Barthel指数评分高于对照组,差异具有统计学意义(P<0.05)。干预后1个月,观察组的Fugl-Meyer量表各维度评分高于对照组,差异具有统计学意义(P<0.05)。结论优质急诊护理用于脑血管意外患者中可提高急救质量,改善意识状态及神经功能,提高日常生活能力,值得临床推广和应用。

早期康复对脑卒中患者活动能力及继发合并症的影响

目的 :探讨早期康复对脑卒中偏瘫患者发病 1个月时的日常生活活动能力及继发合并症的影响。方法 :将 5 7例脑卒中患者随机分为康复组和对照组 ,于患者脑卒中发病后 7～ 2 3d ,平均 (1 5± 4 )d ,用以Bobath为主的运动疗法 ,对康复组 30例偏瘫患者进行康复训练 ,至发病后 1个月时结束 ,对照组 2 7例偏瘫患者不接受康复训练。两组药物治疗方案一致 ,一般资料均衡可比。用临床神经功能缺损 (DDNF)、Fugl Meyer运动功能评定法 (FMA)和Barthel指数 (BI)进行评定。两组分别于康复前后各评定 2次。结果 :康复前 ,FMA上下肢评分、DDNF评分和BI评分除了修饰 1项外 (P =0 .0 4 ,康复组积分高于对照组 ) ,其余各项两组比较统计学差异均无显著性。康复后 ,(1 )在日常生活活动能力方面 :修饰项目由康复前差异有显著性变为差异无显著性 (P =0 .4 7) ;吃饭、床椅转移和步行活动 3项 ,康复组与对照组比较差异接近显著性水平 ;将此 3项康复前后的差值合并后 ,康复组与对照组比较统计学差异有显著性 (P =0 .0 5 ) ,康复组的分值较对照组高 ;两组康复后与康复前比较除了大、小便控制和洗澡 3项统计学差异无显著性以外 ,其余 7项统计学差异均有显著性 (P≤ 0 .0 1 ) ,两组康复后的分值较康复前高。 (2 )在合并症方面

中文版Barthel指数对多中心测评缺血性卒中患者预后的研究

目的评价中文版Barthel指数（BI）量表在我国卒中人群中的信度、效度和敏感度。方法将全国22家医疗中心符合纳入标准的537例中、重度缺血性卒中患者随机分为A组（274例）、B组（263例）,分别给予21d的不同治疗;由经过统一培训的研究人员于纳入研究第21、60、90天的3个时间点,采用中文版BI量表对卒中患者的日常生活活动能力进行测评。通过SPSS13.0统计软件包对有效的BI量表进行信度、效度和敏感度的评价,其中信度检验用Cronbach′sα系数、Guttman split-half和Spearson相关系数来评价。采用人为推理判断方法评价内容效度,采用因子分析法考核量表的结构效度;通过相关分析考察量表的效标效度。各领域敏感度通过配对t检验来评估。结果课题完成治疗共537例,在纳入研究第21、60、90天,分别回收的有效的BI量表为529（A组269份,B组260份）、526（A组269份,B组257份）、525（A组269份,B组256份）份。中文版BI量表内容一致信度的Cronbach′sα系数〉0.92,Guttman split-half系数在0.86-0.89之间,各领域的重测信度系数均〉0.82,显示了良好的信度。中文版BI量表与“准金标准”[（NIHSS）及改良Rankin量表（mRS）]呈适度的相关性（r=0.71-0.75,P〈0.001）,中文版BI量表各时间点的累计贡献率范围为75.03%-76.49%,显示了较好的效度。除A组第21与60天“可控制大便”（P=0.347）,B组“可控制大便”（P=0.095）、“可控制小便”（P=0.399）和B组第21与90天“可控制大便”（P=0.209）外,BI各项显示了良好的敏感度（P〈0.05）。结论中文版BI量表在中、重度卒中患者中,具有良好的信度、效度及敏感度,可作为卒中患者预后的评价指标。

超选择动脉内溶栓治疗脑急性缺血性卒中

目的探讨脑急性缺血性卒中患者动脉内溶栓治疗的安全性和有效性. 方法回顾 1997年 7月至 2002年 7月脑急性缺血性卒中患者 165例,男 97例,女 68例.年龄 32～ 74岁,平均为 58岁.采用超选择动脉内溶栓方法,起病距溶栓的时间为 2～ 24 h.尿激酶以 1～ 1.2万 U/min持续泵入,总量为 50万～ 130万 U,平均 85万 U. 结果颈内动脉系统血管闭塞 108例,椎基底动脉系统闭塞 27例,脑血管造影未见明显异常 30例.闭塞血管再通者,颈内动脉 14例,大脑中动脉 27例,大脑中动脉分支 28例,椎基底动脉系统 19例. 10例因明显的血管狭窄,溶栓后给予球囊扩张、支架置入术.神经系统症状完全恢复正常或明显好转 105例 ,并发脑出血 6例,消化道出血 13例. 结论超选择动脉内溶栓可使血栓局部迅速达到较高的血药浓度,用药总量小,疗效好,见效快,是治疗脑急性缺血性卒中的有效方法.

中国居民吸烟、饮酒等行为因素与脑卒中的关系

目的探讨吸烟、饮酒等行为因素与脑卒中的关系.方法应用Meta分析对有关研究吸烟、饮酒等行为因素与脑卒中关系的文献进行综合定量分析. 结果在检索并纳入的23篇有关研究吸烟、饮酒等行为因素与脑卒中关系的文章中,吸烟、饮酒、体育活动、被动吸烟与脑卒中关系的合并OR值分别是1.86(95%CI: 1.62～2.13)、1.84(95%CI:1.71～1.97),0.41(95%CI:0.08～2.10),3.22(95%CI:2.04～5.07).按脑卒中类型分层合并分析,结果发现,吸烟与缺血性脑卒中、出血性脑卒中的联系的OR值分别为2.60 (95%CI:2.01～3.36 )、2.00 ( 95%CI:1.54～2.60 ).饮酒与缺血性脑卒中、出血性脑卒中的联系的OR值分别为2.10 ( 1.11～3.97)、2.24 (1.62～2.99).结论吸烟、饮酒、被动吸烟是脑卒中及其各亚型的危险因素.

急性脑卒中的就诊延迟因素研究

目的 :分析影响急性脑卒中超早期获得有效治疗的主要就诊延迟相关因素 ,从而寻找可能的解决办法。方法 :采用问卷调查的方法 ,连续收集 2 0 0 2年 9月至 2 0 0 3年 3月来我院就诊的 30 0例急性脑卒中患者 ,采用 χ2 和Logistic回归模型分析就诊延迟的相关因素。 结果 :全部患者均经CT/MRI证实 ,其中脑梗死 2 10例 ,脑出血 80例 ,蛛网膜下腔出血 10例。与就诊延迟最重要的相关因素是抵院方式 ,其次分别为首诊地点、卒中类型和发病地点距医院距离。结论 :导致急性脑卒中患者就诊延迟的相关因素很多 ,其重要原因是患者对急性脑卒中超早期诊治认识不足 ,加强公众相关医学教育对减少这些因素的影响将具有重要意义。